Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Oct 29:73:e327.
doi: 10.6061/clinics/2018/e327.

Goal-directed therapy in patients with early acute kidney injury: a multicenter randomized controlled trial

Cristina Prata Amendola  1 , João Manoel Silva-Jr  2   3 , Taisa Carvalho  1 , Luciana Coelho Sanches  1 , Ulysses Vasconcelos de Andrade E Silva  1 , Rosana Almeida  1 , Emmanuel Burdmann  4 , Emerson Lima  5 , Fabiana Ferreira Barbosa  5 , Renata Souza Ferreira  5 , Maria José C Carmona  3 , Luiz Marcelo Sá Malbouisson  3 , Fernando A M Nogueira  2 , José Otavio Costa Auler-Júnior  3 , Suzana Margareth Lobo  5
Affiliations
Randomized Controlled Trial

Goal-directed therapy in patients with early acute kidney injury: a multicenter randomized controlled trial

Cristina Prata Amendola et al. Clinics (Sao Paulo). .

Abstract

Objectives: Acute kidney injury is associated with many conditions, and no interventions to improve the outcomes of established acute kidney injury have been developed. We performed this study to determine whether goal-directed therapy conducted during the early stages of acute kidney injury could change the course of the disease.

Methods: This was a multicenter prospective randomized controlled study. Patients with early acute kidney injury in the critical care unit were randomly allocated to a standard care (control) group or a goal-directed therapy group with 8h of intensive treatment to maximize oxygen delivery, and all patients were evaluated during a period of 72h. ClinicalTrials.gov: NCT02414906.

Results: A total of 143 patients were eligible for the study, and 99 patients were randomized. Central venous oxygen saturation was significantly increased and the serum lactate level significantly was decreased from baseline levels in the goal-directed therapy group (p=0.001) compared to the control group (p=0.572). No significant differences in the change in serum creatinine level (p=0.96), persistence of acute kidney injury beyond 72h (p=0.064) or the need for renal replacement therapy (p=0.82) were observed between the two groups. In-hospital mortality was significantly lower in the goal-directed therapy group than in the control group (33% vs. 51%; RR: 0.61, 95% CI: 0.37-1.00, p=0.048, number needed to treat=5).

Conclusions: Goal-directed therapy for patients in the early stages of acute kidney injury did not change the disease course.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
Randomization and follow-up of patients in the control and GDT groups.
Figure 2
Figure 2
Goal-direct therapy (GDT) algorithm used in this study.
Figure 3
Figure 3
Oxygen delivery index (IDO2) and systemic vascular resistance index (SVRI) in the GDT and control groups during the 8-h study period.
Figure 4
Figure 4
Central venous oxygen saturation and serum lactate levels in the GDT and control groups during the 8-h study period.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kellum JA, Sileanu FE, Murugan R, Lucko N, Shaw AD, Clermont G. Classifying AKI by Urine Output versus Serum Creatinine Level. J Am Soc Nephrol. 2015;26((9)):2231–8. doi: 10.1681/ASN.2014070724. - DOI - PMC - PubMed
    1. Pinsky MR, Brochard L, Kellum JA. Ten recent advances that could not have come about without applying physiology. Intensive Care Med. 2016;42((2)):258–60. doi: 10.1007/s00134-015-3746-9. - DOI - PubMed
    1. Costa e Silva VT, de Castro I, Liano F, Muriel A, Rodriguez-Palomares JR, Yu L. Sequential evaluation of prognostic models in the early diagnosis of acute kidney injury in the intensive care unit. Kidney Int. 2009;75((9)):982–6. doi: 10.1038/ki.2009.3. - DOI - PubMed
    1. Hoste EA, Schurgers M. Epidemiology of acute kidney injury: how big is the problem. Crit Care Med. 2008;36((4 Suppl)):S146–51. doi: 10.1097/CCM.0b013e318168c590. - DOI - PubMed
    1. Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10((3)):R73. doi: 10.1186/cc4915. - DOI - PMC - PubMed

Publication types

Associated data